Healthcare Cost Containment

              Industry experience that delivers sound judgment.   

                   Real world solutions for complex challenges. 

Pierce LLC’s Healthcare Cost Containment attorneys have created a unique practice representing the interests of Payers focusing on fraud detection, prevention and overpayment recovery.

The Practice is distinguished by our progressive approach to understanding our clients’ business and legal challenges and by our pro-active focus on successful solutions compatible with our clients’ business and cost objectives. It is an approach that has earned the practice relationships with clients throughout the United States and respect of its peers. The defining elements of the Practice are its attorneys’ history, covering over two decades of success in and out of the courtroom, its ability to design creative and cost effective legal strategies to obtain early and decisive victories and favorable settlements, and its close working relationship with clients. These elements allow them to work as a team, with an intrinsic understanding of the clients definition of a successful outcome. 

We have extensive investigative and data analysis capability. Most of the Practice’s cases in recent years have involved sophisticated investigations that have been conducted outside the formal civil discovery process. We pioneered the use in multi-payer cases of technologically contemporary automated paid claims data assembly and analysis. This automated approach is a unique approach and a core tool in the Practice’s liability and damages analysis. We, in conjunction with our automated analysis of multi-clients paid claims data, continue to monitor and address concerns regarding privacy and the confidentiality of individual health information. 

 In order to prove liability, we have designed and conducted regression analysis with statistical analytics using outside Ph.D. consultants and statistical experts in Healthcare economics.  Our approach is straightforward, effective and unconstrained by geographical boundaries. We represent healthcare payers, property/casualty insurers and self-funded plans in a variety of claim cost containment cases against individuals, laboratories, pharmacy benefit programs, national medical providers, hospitals, medical clinics and others engaged in fraud. The practice works closely with prosecutors around the country in pursuing both civil recoveries and seeking criminal penalties for fraudulent providers, as well as obtaining restitutional awards for our clients.  

We are often retained by groups of healthcare payers in large national overpayment recovery cases. Such collective action allows the individual companies to dramatically reduce costs and increase strength. In such group cases, the Cost Containment Practice facilitates a collective investigation and litigation process that honors the ultimate decision making of each individual participant, while building a coordinated case into a more formidable and cohesive whole. To date, the results of these cases for over two dozens payers include a number of eight figure settlements. 

We offer our strong litigation experience, including coordinating with law enforcement, insurance regulators and inspector general offices. The practice has an understanding of healthcare billing and reimbursement, contracting, ERISA, state tort law, Medicare and Medicaid. To date our attorneys have recovered over 4.4 million dollars on behalf of the United States Government and State Governments and over 245 million dollars for over two dozen commercial group healthcare and property casualty payers and Taft-Hartley Benefit Funds arising from abusive healthcare claim practices. 

We provide our clients with a team whose experience spans government, law enforcement, private practice, insurance and healthcare. The Practice is organized as a core group of attorneys that in turn networks with other attorneys, investigators, data analysts and programmers and industry experts to form a tailored and specific case team. All of the Practices attorneys are accomplished litigators who bring to every case an effective combination of general litigation skills and expertise in healthcare provider claim overpayment matters. The cases handled by the Practice involve complex factual and legal issues and often are of tremendous significance to our clients from a damage as well as operational perspective.